~~~~~

~~~~~~~~~~~~~ ~~~ ~~~~~~~~
~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~ ~
    ~~~~~~ ~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~ ~~~~~~~~~
    ~
        ~~~~ ~ ~~~~~~~~~~~~~~
        ~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
    ~

    ~~~~~~ ~~~~~~ ~~~~ ~ ~~~~ ~~~~ ~

    ~~~~~~ ~~~~~ ~~~~~~~~
    ~
        ~~~~~~ ~~~~~~ ~~~~ ~ ~~~~ ~~~~ ~
    ~
~

<h1>New Customer</h1>
<form method="post" class="form-horizontal">
    <div class="text-danger"></div>
    <div class="form-group">
        <label class="col-md-2 control-label">~~~~~</label>
        <div class="col-md-10">
            <input class="form-control" />
            <span class="text-danger"></span>
        </div>
    </div>
    <div class="form-group">
        <div class="col-md-offset-2 col-md-10">
            <button type="submit" class="btn btn-primary">Save</button>
        </div>
    </div>
</form>
